Early laparoscopic cholecystectomy for acute cholecystitis following the Tokyo Guidelines 2018 : a prospective single-center study of 201 consecutive cases
© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature..
BACKGROUND: Early laparoscopic cholecystectomy (ELC) for acute cholecystitis (AC) poses multiple challenges. The Tokyo Guidelines 2018 (TG18) eliminated the time limit (< 72 h) and expanded the surgical indication to severe AC. This study aimed to evaluate the clinical outcomes of ELC for AC following the TG18 in a single high-volume center.
METHODS: From 2019 to 2021, we managed all AC patients with a TG18 flowchart and prospectively enrolled those who underwent ELC within 7 days of symptom onset. The primary outcome was overall morbidity, with a comparison between mild (Grade I) and moderate/severe (Grade II/III) AC.
RESULTS: During the study period, 201 patients underwent ELC was for Grade I (56.2%), II (40.3%), and III (3.5%) ACs. Mean age was 69 ± 15.2 years and time to surgery from symptom onset was 0 (12.9%), 1-3 (66.7%), and 4-7 days (20.4%). Mean operative time and blood loss were 118.9 ± 42.7 min and 57.8 ± 99.4 mL, respectively. The critical view of safety (CVS) was achieved in 76.1% of patients, and bailout procedures were performed in 21.4%. There were no open conversions or bile duct injuries. Major morbidities (Clavien-Dindo classification ≥ IIIa) were observed in 5.5% of cases and mortality in 0.5%. Comparing Grades II/III to Grade I, operative time was longer (112.3 vs. 127.3 min, p = 0.014), blood loss was higher (40.3 vs. 80.1 mL, p = 0.005), the CVS rate was lower (83.2 vs. 67.0%, p = 0.012), and the major morbidity rate was higher (1.8 vs. 10.2%, p = 0.012). In the subgroup analysis of Grade II/III, there were no significant differences in major morbidities (p = 0.288) between the two groups (0-3 vs. 4-7 days).
CONCLUSION: ELC for AC following TG18 is feasible with low morbidity rates. However, ELC for Grade II/III ACs remains challenging, and surgeons must carefully assess intraoperative difficulties and surgical risks before proceeding.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:37 |
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| Enthalten in: |
Surgical endoscopy - 37(2023), 8 vom: 28. Aug., Seite 6051-6061 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Mishima, Kohei [VerfasserIn] |
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| Links: |
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| Themen: |
Acute cholecystitis |
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| Anmerkungen: |
Date Completed 14.07.2023 Date Revised 25.07.2023 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1007/s00464-023-10094-x |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature. | ||
| 520 | |a BACKGROUND: Early laparoscopic cholecystectomy (ELC) for acute cholecystitis (AC) poses multiple challenges. The Tokyo Guidelines 2018 (TG18) eliminated the time limit (< 72 h) and expanded the surgical indication to severe AC. This study aimed to evaluate the clinical outcomes of ELC for AC following the TG18 in a single high-volume center | ||
| 520 | |a METHODS: From 2019 to 2021, we managed all AC patients with a TG18 flowchart and prospectively enrolled those who underwent ELC within 7 days of symptom onset. The primary outcome was overall morbidity, with a comparison between mild (Grade I) and moderate/severe (Grade II/III) AC | ||
| 520 | |a RESULTS: During the study period, 201 patients underwent ELC was for Grade I (56.2%), II (40.3%), and III (3.5%) ACs. Mean age was 69 ± 15.2 years and time to surgery from symptom onset was 0 (12.9%), 1-3 (66.7%), and 4-7 days (20.4%). Mean operative time and blood loss were 118.9 ± 42.7 min and 57.8 ± 99.4 mL, respectively. The critical view of safety (CVS) was achieved in 76.1% of patients, and bailout procedures were performed in 21.4%. There were no open conversions or bile duct injuries. Major morbidities (Clavien-Dindo classification ≥ IIIa) were observed in 5.5% of cases and mortality in 0.5%. Comparing Grades II/III to Grade I, operative time was longer (112.3 vs. 127.3 min, p = 0.014), blood loss was higher (40.3 vs. 80.1 mL, p = 0.005), the CVS rate was lower (83.2 vs. 67.0%, p = 0.012), and the major morbidity rate was higher (1.8 vs. 10.2%, p = 0.012). In the subgroup analysis of Grade II/III, there were no significant differences in major morbidities (p = 0.288) between the two groups (0-3 vs. 4-7 days) | ||
| 520 | |a CONCLUSION: ELC for AC following TG18 is feasible with low morbidity rates. However, ELC for Grade II/III ACs remains challenging, and surgeons must carefully assess intraoperative difficulties and surgical risks before proceeding | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Acute cholecystitis | |
| 650 | 4 | |a Bailout procedure | |
| 650 | 4 | |a Early laparoscopic cholecystectomy | |
| 650 | 4 | |a The Tokyo Guidelines 2018 | |
| 650 | 4 | |a The critical view of safety | |
| 700 | 1 | |a Fujiyama, Yoshiki |e verfasserin |4 aut | |
| 700 | 1 | |a Wakabayashi, Taiga |e verfasserin |4 aut | |
| 700 | 1 | |a Igarashi, Kazuharu |e verfasserin |4 aut | |
| 700 | 1 | |a Ozaki, Takahiro |e verfasserin |4 aut | |
| 700 | 1 | |a Honda, Masayuki |e verfasserin |4 aut | |
| 700 | 1 | |a Mori, Shozo |e verfasserin |4 aut | |
| 700 | 1 | |a Funamizu, Naotake |e verfasserin |4 aut | |
| 700 | 1 | |a Tsutsui, Atsuko |e verfasserin |4 aut | |
| 700 | 1 | |a Okamoto, Nobuhiko |e verfasserin |4 aut | |
| 700 | 1 | |a Marescaux, Jacques |e verfasserin |4 aut | |
| 700 | 1 | |a Wakabayashi, Go |e verfasserin |4 aut | |
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